Adult Behavioral Health Home and Community Based Services Quality - PowerPoint PPT Presentation

Adult Behavioral Health Home and Community Based Services Quality and Infrastructure Program: Improving Lives

April 30, 2018 2 Agenda for the Day • Vision and Overview: HARP and BH HCBS • Recovery Coordination of BH HCBS (SDE) • Infrastructure and Quality Funds: How it all works together • Q & A and wrap up

April 30, 2018 3 Clinical Transformation • In 2015 NYS began to implement the vision of the MRT to transform the adult system of care for individuals with mental health and substance use disorders. • This vision is to increase community based services, reduce reliance on inpatient services and allow individuals who may experience mental health or substance use disorders to achieve their life goals. • The following points were identified to accomplish this: – Person Centered Care – Recovery-Oriented – Integrated – Data Driven – Evidenced Based

April 30, 2018 4 Rehabilitation and Recovery Vision • It is about the person - helping people live a life in the community, get a job, have successful relationships and go to school. • The system should include a broad range of services that support recovery from mental illness and/or substance use disorders. • These services support the acquisition of living, vocational, and social skills, and are offered in settings that promote hope and encourage each member to establish an individual path towards recovery.

April 30, 2018 5 The Health and Recovery Plan (HARP) • HARP is a specialty Medicaid Managed care Plan and began in October 2015. • HARPs offer an enhanced array of services including Adult Behavioral Health Home and Community Based Services (BH HCBS). • All HARP enrollees are eligible for Health Home Care Management (HHCM).

April 30, 2018 6 BH HCBS Find Housing. Live Independently. Manage Stress. Prevent Crises. • Psychosocial Rehabilitation • Short-Term Crisis Respite • Community Psychiatric Support • Intensive Crisis Respite and Treatment • Habilitation • Non-Medical Transportation for Get Help from People who Have Been needed community services There and Other Significant Supporters. • Peer Support Services Return to School. Find a Job. • Family Support and Training • Education Support Services • Pre-Vocational Services • Transitional Employment • Intensive Supported Employment • Ongoing Supported Employment

April 30, 2018 7 BH HCBS Access: Implementation Challenges • Historically, NYS Eligibility assessment could only be done for those enrolled in a Health Home – Low Health Home enrollment of HARP members • Engagement, outreach and education of workforce and consumers • Engagement throughout the workflow • Few referrals from HH Care Management Agencies (CMAs) to BH HCBS • NYS Eligibility Assessment billing challenges • Workforce and financial viability issues due to low volume of service recipients

April 30, 2018 8 Existing Initiatives to Improve Access • Removal of the “full” Community Mental Health Assessment (CMHA). • Abbreviated Assessor training for NYS Eligibility Assessment – originally 12+ hours down to approx. 3. • Resolved Issues with payment to CMA for NYS. Eligibility Assessment: - Billing Roster eliminated (not effective) - Direct billing to eMedNY / edit resolved

April 30, 2018 9 Existing Initiatives to Improve Access (cont.) • Provider Designation Attestation Form to eliminate Hiatus status. • Revised BH HCBS Workflow (October 2017). • BH HCBS Plan of Care template to be offered to Managed Care Organizations (MCOs), Recovery Coordination Agencies (RCAs) and Health Homes to support more intuitive focus on integration and person-centered rehab goals • Working through billing difficulties for BH HCBS with providers and MCOs.

April 30, 2018 10 Existing Initiatives to Improve Access (cont.) • Consumer Education Initiatives:  Adult Behavioral Health Medicaid Managed Care Educational Video Series  Newly Available BH HCBS Brochures and Previously-released HARP print materials available for mass production and outreach  All materials can be found on the OMH Medicaid Managed Care Consumer Education Webpage

April 30, 2018 11 HCBS Dashboard Data (04/24/18) HARP Enrolled 108,217 HH Enrolled 36,315 (34%) HCBS Assessed 17,018 HCBS Eligible 15,358 LOSD Requested Only 1.8% of HARP enrollees 6,195 have received a BH HCBS service HCBS Authorized 2,387 HCBS Claimed 1,921

April 30, 2018 12 New Initiatives Working Together: RCA, Quality and Infrastructure Opportunity • Achieving rapid access to BH HCBS by: – strengthening regional stakeholder partnerships for solutions within a define catchment area, – opening the door to assessment and care planning for those not enrolled in Health Home through contracted Recovery Coordination Agencies. • Increasing referrals to BH HCBS to active providers. • BH HCBS uptake will support sustainability. • Quality and Infrastructure program can support RCA implementation. • Supporting VBP readiness.

13 Access to Adult BH HCBS for Non-Health Home: Recovery Coordinators

April 30, 2018 14 How Does HCBS Benefit HARP Enrollees? • Treatment and Rehabilitation – Focus on symptom management vs. meaningful life role goals • Engagement of high-need individuals with behavioral health disorders through: – Flexible services – can be provided in the individual’s home or in the community, based on individual need or preference – Person-centered Care planning - specifically tailored to the individual’s preferences, strengths, needs and goals – Services are chosen by the member: type of service and provider of service • Empowering individuals to direct their path to recovery . • Supported by rehab, peer, family, and other specialists to help individuals gain the skills necessary to attain life goals, recovery and independence.

April 30, 2018 15 Why Does Access to HCBS Require HH / RCA? • HCBS is different from traditional models – An array of rehab services vs. comprehensive program model – Provided around the person’s individual circumstances and needs (flexible) • An eligibility assessment is required – Independent assessment of barriers, needs, skills, and service preferences • Requires recovery planning by a service coordinator – Identifying the individual’s life role goal – Ensuring services have been chosen by the person – Planning services in an integrated way – HCBS complement each other AND the other services person receives – Services will help person address barriers and attain goal

April 30, 2018 16 HARP, Health Home, and Adult BH HCBS • Most HARP enrollees will be eligible for BH HCBS (determined by an eligibility assessment). • All HARP enrollees are eligible for Health Home Care Management (HHCM). HHCMs are given an increased monthly rate to provide enhanced care coordination to HARP enrollees, as needed to support their needs and access to HARP benefit package. • MCOs, HHCMs, and providers will work together to assist HARP enrollees in accessing BH HCBS; see BH HCBS Workflow guidance.

April 30, 2018 17 HCBS Dashboard Data (04/24/18) HARP Enrolled 108,217 HH Enrolled 36,315 (34%) HCBS Assessed 17,018 HCBS Eligible 15,358 LOSD Requested 6,195 HCBS Authorized 2,387 HCBS Claimed 1,921

April 30, 2018 18 Expanding Access to Rehab Services for HARP Enrollees • Currently, 66% of HARP enrollees are not enrolled in HH. MCOs will contract with eligible entities to provide assessment and care planning of BH HCBS for HARP enrollees not enrolled in a Health Home. • HARP members who are not enrolled in HH will have their NYS Eligibility Assessment and HCBS Plan of Care done through a State Designated Entity contracted with the MCO as a Recovery Coordination Agency (RCA) for BH HCBS. • HARP members who are not HH-enrolled may best engage with providers who have existing therapeutic and supportive relationships. These providers may be best at identifying recovery goals and linking the member to HCBS.

April 30, 2018 19 The State Designated Entity (SDE) • Agencies that meet the following State-issued criteria are State Designated Entities for Adult BH HCBS: − Agencies or community-based organizations that are NYS- designated HHs, or affiliated with a HH, and who employ individuals meeting the NYS Assessor qualifications for Adult BH HCBS. − An agency is considered affiliated with a HH when the agency has a contractual relationship with a NYS-designated HH for the provision of HH Care Management (HHCM) services . • The State provided MCOs with a list of State Designated Entities eligible to become a contracted RCA, to help MCOs begin contracting activities.

April 30, 2018 20 Becoming a Contracted Recovery Coordination Agency (RCA) for Adult BH HCBS • MCOs will reach out to State Designated Entities who they would like to contract with as Recovery Coordination Agencies. • Agencies who meet the SDE criteria can reach out to MCOs to express interest in contracting as an RCA, subject to MCO approval. • MCOs must contract with a sufficient number of RCAs to meet the need in each county. • MCOs may amend existing contracts with eligible agencies. NOTE: An SDE must have a contract as a Recovery Coordination Agency in place with an MCO before it can begin completing assessments and BH HCBS Plans of Care for individuals not enrolled in HH.